Half-time team talk

At special request from one Ryan Musy, I will try and put in more photos of myself from now on. You're welcome Ryan!

The taxis parked on the main road for two
days. Apparently they can get vicious;
puncturing tyres of people who try to pass.

The last week has been political in Bolivia. And the hospital has been resultingly quiet. On Monday and Tuesday there was a regional ‘bloqueo’ – a blockade on the streets. The local drivers of taxis and trufis (little minibuses which are the cheapest and most amazingly efficient way of getting around) want the government to improve the road from here into the city – upgrading from a basic two way road to a multi-lane highway. You can see why; the current road is just begging for accidents the way everyone drives..

As a result nobody could get up to the hospital, so no patients and very few staff were here on Monday and Tuesday. I had no such excuse, since I can wake up at 7.50 and still be in the hospital by 7.55. With absolutely nothing happening there I took the day off and spent all day reading and playing football. Not too bad.

That bloqueo finished yesterday (I think because the drivers were bored rather than the government promised to improve the road) but a new, national bloqueo started up today instead, ‘scheduled’ to last for 72 hours. This one is throughout Bolivia and is because of the miners demanding that the government hand back over control of the mines to the people..  I don’t think they’ve chosen the timing too well – the president Morales is overseas right now, fighting for the right for Bolivia to grow more Coca I think..

Another game of football with the bomberos after no patients
came to hospital. I managed to persuade them to play so
that we could only score with our heads. Advantage Angus.

Apparently these sort of protests happen at least once a month here, and although the majority of locals I’ve spoken to agree with the principles, the actual blockade is completely disabling for a couple of days! Nobody can get to work, do their shopping, travel..

Yesterday was a good day in the hospital though – I joined the surgeon for a couple of appendicectomies, and when he was finishing up an emergency came in. A fifteen year old girl had had an accident with a bike and a tree (Bolivians like to play ’how many people can you fit on a bike/motorbike’; often parents, children and a baby..) and had to come into surgery urgently. We opened her up and found a huge amount of bleeding in her abdomen – she had ruptured her spleen. The surgeon put in a few stitches to try and stop the bleeding, and then took out her spleen. Once she was stabilised we were all able to relax a bit more; the theatre staff all pulled out their mobile phones to take photos of the spleen and the poor girl!

The operation was finished off by slicing up her spleen into little segments and then stitching these portions back into her peritoneum (the fatty covering over all the organs in the abdomen). I had no idea this could be done. We left some gauze and a big bit of plastic in her abdomen, and only put in some loose stitches. She’s getting opened up again on Friday morning to finish the job..

Ancient Incan sacrificial table on Isla Del Sol. The
lightning came shortly afterwards..

Proof of the snow on Lake Titicaca. 

After four weeks of trying, I’ve finally managed to get a photo of the Polo family. Here they are -  Neco, Elba (Neco’s mum), Rose (Neco’s wife), Bruno (8) and Hugo (10). They are our hosts here, they give us a huge cooked lunch every day and keep the cupboards stocked so that we can get our own breakfast and tea every day. Neco, Rose and the kids spent 4 years in Canada so speak perfect English. Elba only speaks Spanish, but is great because if you suggest to her that you’d like to learn how to make a cake, she’ll just go ahead and make it for you. What a hero.

Bruno, Neco, Elba, Rose and Hugo. The Polo family.

Salar De Uyuni ("Lake Titicaca")

Incan Ruins and impending lightning.

 This weekend marked the 200th anniversary of Cochabamba's independence (from what, I'm not too sure). To celebrate we were given Friday off from the normally rigorous schedule (ha), and so we decided to use our long weekend to try and go to the salt flats at Salar de Uyuni - the famous tourist attraction of miles and miles of mesmerising and hypnotic flat, white salt.

However, due to bus and train difficulties, our trip to Uyuni ended shortly after it began, when we arrived at the bus station. Undeterred by this, we made some last minute plans to go instead to La Paz, and from there on to Lake Titicaca, straddling the border of Bolivia and Peru, and claiming to be the highest navigable lake in the world (this depends on what you want to navigate I guess).

We took an overnight bus to La Paz, arriving early on Saturday morning. From here it was another 3 hours on the bus to Copacabana, on the shores of Lake Titicaca, and from here another 2 hours on the boat to an island called the Isla del Sol, where we decided to spend two nights.

Incan Ruins on Isla del Sol

The Incans liked to claim that in the Isla del Sol the sun itself was born.
The Lonely Planet like to claim that it is still going strong.
And it does shoot up as if on a piece of elastic at 6 in the morning, before hanging overhead angrily and lazily for the next 11 hours before dropping suddenly back down on the other side of the island. But once it's down, it seems like other weather elements have free reign..

On Saturday once we arrived we 'checked in' to one of the hostels at the north end of the island - paying the equivalent of £2 for a bed (with 4 blankets) and little else. Then we walked for a couple of hours to explore some Incan ruins, enjoying the warm weather. Once at the tip of the island we watched the sun go down before noticing some ominous dark clouds heading our way, accompanied by lightning. We began to head back to the village, but were too late. The hail began to fall when we were halfway back, stinging the back of my neck and my bare arms, until eventually it looked more like Scotland at Christmas with a thick snowfall than Bolivia in September! We were glad of the multiple blankets that night (as well as wearing whatever dry clothes I had left).

Local Llama

Cocaine in a cup. Disclaimer - not actual cocaine. This is
Coca leaves, the natural plant grown and used in Bolivia
to make drinks or to be chewed to help with altitude,
sickness, sore head, basically anything that  hurts. Only
once it's mixed with kerosene, acids, petrol and other
chemicals..

Sunday we walked from the north end to the south end, enjoying amazing views over both sides of the island, getting through copious volumes of water and being overtaken by herds of cows, donkeys and llamas. It took pretty much the whole day until we got to the south village, where we stayed another night. Another lightning storm came this night as well, thankfully only once we were safely ensconced in our rooms (going to bed at 8.30 proved very wise on our part).

Taking a break looking over Lake Titicaca.

No cars are allowed on the island (there are no roads anyway) so the only sounds are of birds and animals. The little restaurants and shacks scattered over the island serve fizzy drinks and delicious fresh fish. A very peaceful weekend!

We arrived back in Cochabamba at 6am on Tuesday after another overnight bus back from La Paz. Just in time for the 8am ward round in the hospital..


Sadly Tuesday night was a disappointment. The local football team in Cochabamba is called Aurora, and this season they qualified for the sudamericana cup (kind of like the europa league in Europe). They played 'Quito' from Ecuador in the 3rd round, and had to overcome a first leg deficit. Neco (our Bolivian host here) is a season ticket holder and took us along to the game. Sadly, despite investing in some high quality Aurora merchandise to show my solidarity with the team, they lost 3-1 and bowed out of the sudamericana cup for this year.

Intese game

Riotous atmosphere

Juxtapositions in the jungle

Bolivia is a land of contrasts.

- Walking down the crowded streets of the marketplace in La Cancha (the biggest market in Bolivia) you get hit with amazing smells of fried chicken, baked empanadas (little rolls filled with ham or cheese), incense or the fresh juicy pineapple and oranges being cut open. But just when you take a big whiff to enjoy the moment, you realize you’ve passed inadvertently on into the 'sewage and urine' area.

- Or seeing Bolivians working all day long trying to sell juice or potatoes or second hand CDs in an attempt to make a living, while they’re chatting away on their top of the range mobile phone.

- Or the fact that everyone here is always late, and yet when you drive anywhere people always seem to be in such a hurry to overtake on blind corners, or even in the face of oncoming lorries. This is a great irony.

- Or being in a climate which is cold and dry and arid, then only a couple of hours away being in the hot and humid and noisy jungle.

This last one was how we spent yesterday.

After leaving at “5”am (although our driver Manuel eventually turned up to get us at 6) we were prepared for a 3 to 4 hour drive over the mountain and down into the jungle area of Villa Tunari, right on the edge of the Amazon.

Local swimming river. The jump from
 that concrete is exhilarating.

After 6 hours we finally got there – at first we were delayed by a landslide on the hill, and then by the fact that our battery ran flat as we tried to start moving again. Imagine many angry Bolivian lorry and bus drivers tooting and beeping at us as they went round our stranded vehicle on both sides (impressive enough on what was only just a two lane road), until we flagged someone down for help.

Once in Villa Tunari we refreshed ourselves after the cramped car ride by jumping into the river. Amazingly warm! It was full of locals taking the opportunity to soap up get the laundry done. One guy was even struggling to give his dog a bath in there.

Then we had some lunch – the delicacy there is the fish, since it’s a river town. Traditional jungle food of friend banana, rice and yucca. Delicious.

Fish, banana, rice and yucca.

After lunch we went to one of the parks where you can walk up through the jungle, looking out for monkeys, pumas, exotic birds and so on. They charged 10Bs for every camera to take in so we just took the one, and I have no photos from it yet. But I had a great time sweating my way through the trees, swinging from vines, exploring waterfalls and climbing through river beds. We were out of the jungle just in time to jump back in the river afterwards to wash away the sweat.

It’s fitting that as we left another contrast was on show. Our last swim in the river was in bright daylight, and a relief to get out of the hot humid and sticky air. Within half an hour of that we were in the car driving back up the mountainous road in the pitch blackness of night and with heavy rain pounding on the windscreen and lightning flashing through the sky.

Cheap living

Bolivia is really cheap. Here are some things I've been spending hard earned bolivianos on;

Public Fusbal tables. Good
place to make friends!

- 1 hour bus ride into town: 3 Bolivianos (about 30p)
- Public fusbal tables in the park: 3 Bolivianos for about half an hour.
- Entry to national park: 2.50 Bolivianos (25p)
- Professional good quality haircut: 8 Bolivianos (80p)!! This one in particular amazes me, since I used to think £8 was a good deal at home. No longer.
- An ice cream: 1 Boliviano (10p)
- A bag of fanta: 1.50 Bolivianos (15p) This is clever; to recycle the bottles they just pour it into a plastic bag for you and give you a straw. 
- A concert with the allegedly biggest traditional band in Bolivia (and possibly South America) next Thursday - The Kjarkas: 120 Bolivianos (£12). I'm actually not sure if this is good value, having never seen a band at home. But it probably is.

Apparently the average Bolivian wage though is only 1000 Bolivianos a month. This is low because of the high number of people working really poorly paid jobs. A nurse at the hospital here could expect to earn about 2300 bolivianos/month. This is about £230 a month, or £2760 annual wage. I guess although that wouldn't get you anywhere in the UK, here that is enough to live comfortably..

Apart from marveling at the value of things, this week has been fairly busy. We are now in more of a routine - at 8am we start at the hospital here with a ward round or a presentation from one of the Bolivian interns (I understood about 60% I think, mainly because she had slides and partly because medical words in spanish are very similar to medical words in english). After that we can sit in on the clinics with the doctors, or see what surgery is on. I assisted a nice man called Alfredo in doing a laparoscopic cholecystectomy the other day. Surgery is very hygienic here, after scrubbing up we get our arms sprayed with iodine just to be extra safe. But in other respects they are very different from UK procedures - gloves are washed at the end in order to be re-used, gowns and sheets are all washed, they stapled up the scars instead of stitches (very quick!), and because they didn't have the right bag they normally use to take out the gall bladder they just used half a glove. Effective.
Alternatively we can go into the clinic in cochabamba in the morning, which is slightly busier and possibly better for teaching.

Lunch is at 12.30 every day and usually goes on until 2ish. We take our time over things. Then we have a couple of hours to ourself. I tried to be keen and go to the hospital one day, but was told that they don't do things in the afternoon and I should go home again.

Me ad Mike with Jose and Jonny, during their shift. What heroes.

At 4 we go across to our neighbours the bomberos. We usually play football (although at the time of writing our ball is sadly deflating with a puncture. Nobody can be blamed) and chat to them. On wednesday though we asked them if they could recommend a walk for us. Jose and Jonny weren't really doing much since there were no fires to put out, so they gave us a lift in their fire engine (although there are no hoses or ladders, so it's more of a standard van with 'bomberos' painted on the side). We went to pairumani ecotourist park, about 10 minutes drive away, and then walked up through the woods for half an hour to a viewpoint at the top. The firemen had their radio with them just in case there was an emergency, but I'm not sure what we would have done if we had to run down the hill! I wonder how many firemen at home would agree to give us a lift to a hill and then spend the afternoon with us there!

The local school leading the parade.

As hospital representatives we were
considerably less well organised.

Oh and we were also in a parade to commemorate the anniversary of Vinto (the town we are next to, outside Cochabamba.)







Semi-highlight of the week: finding an ex-pro basketball player from Argentina in the doctors to get his broken finger seen to and having some good chat about Andy Murray's chances in the US open.

Primera Semana

Greetings.

It feels strange that we're already at the end of our first week.. (Bolivians start their weeks on a Sunday)

Ambulance for the street clinic

Things have been picking up here - on Thursday we took one of the hospital ambulances and drove into the local town (Vinto) to carry out a free street clinic. People usually pay for their care here, so we gave them the opportunity to get their height and weight and blood pressure recorded before speaking to a doctor and getting either some advice or some free medicines (although the options were severely limited, and we spent the night before throwing out a holdall full of expired drugs!)

It was fun to be able to interact with the locals as well as doing a bit of medicine; some of the people were amazing! One woman claimed to be 93 (I hope I look as good as her when I'm 93), and after having had her blood pressure taken she decided that she couldn't wait around for the doctor so went on to the market to do her shopping before coming back. Then she had to go home again to cook lunch for her husband (imagine, a husband unable to cook for himself?!).

Does she look 93?! No.

There were more sobering patients as well though. One young man had what looked like a tumour growing out of his knee. It was huge and white and knobbly, and there was absolutely nothing that we could do with our limited supplies of painkillers and cough medicine. We tried to persuade him to go to the doctor, but he said that hospitals in Bolivia cost too much money - the doctors are too greedy and proud.
Then a 24 year old lady who had been waiting politely in the queue tapped the doctor on the shoulder and told her that she was bleeding profusely. When she turned round there was blood all the way down the back of her trousers and staining the wall behind her. She was bundled into the ambulance and raced up to the hospital, leaving the street clinic temporarily halted. We found out later that she had gone to a backstreet clinic to have an abortion (again, possibly due to the costs of healthcare here, or due to the cultural aversion to abortions), which had gone wrong and ruptured her uterus. She ended up having a hysterectomy in the hospital. As damaging as it is to be unable to bear children in a culture where children look after their parents, the on-call doctor thought she was going to die when she arrived, so it was a blessing that she survived.

We also managed to spend an afternoon at an orphanage - giving a basic medical check to about 30 boys who live there, between the ages of about 5 and 13. It was good to get stuck in, but again frustrating when we saw ear infections or tonsillitis and were unable to really do anything except recommend they go to the doctor! Sadly the chances of the orphanage paying the fees for medical care are slim unless the boy is close to death. The boys were all full of energy though - playing with stethoscopes and climbing on our backs and running outside to swim in their 'fountain'. So it was a satisfying afternoon to spend with them.

El Cristo de la Concordia.

The weekends are free time - today we went into Cochabamba and climbed up to the Cristo (similar to the famous Christ the redeemer in Rio de Janeiro, but slightly taller than their one! The Brazilian one is 33m high, one metre for each of the years that Christ lived. The Bolivians claim that since he lived for 33 and a bit years then they are justified!) Great views over the city.

Halfway up the 1399 steps to the Cristo.

Tomorrow is national no transport day. We have been painted an idyllic picture of hundreds of Bolivians running free on the roads with balls and tyres and games, free from the perils of nasty cars and buses. Whether that happens or not will have to be seen, but it means after the local church service a relaxing day in the house, or within walking distance..

I'll leave with a more cheerful story. Our relationship with the local firemen (bomberos) has been strained after I accidentally broke their homemade goalposts the other day. We were having a casual kickabout and my gentle, slow, lofted shot hit the wall behind the goal, bounced back, bobbled a few times and then came to rest against their post. With a slow ponderous creak it began to topple over, snapping in half. Luckily the firemen are savvy folk, they took off the tape from their hose so that we could use it to fix their goals! I assume they are more dependent on having goalposts than being able to put out fires..

Thanks for all the emails! I'm sorry I haven't been able to reply to them individually, but I do enjoy reading them! I have also invested in a Bolivian sim card, the number I think is 0059179770156.